Hiding and healing: resolving the suicide of a parent or sibling

Support After Suicide: A Thematic Analysis of Siblings' Experience

Suicide is a worldwide phenomenon resulting in the deaths of more than 700,000 people each year. For every suicide, there are those left behind. The research on sibling's experiences of grief and the support they require after the loss of their sibling is limited. This study explored the experiences of grief and the support siblings bereaved through suicide experienced. Support groups passed on study information to individuals they felt were suitable for participation. Ten adult siblings were interviewed for the study. Thematic analysis was used to find three themes, shared understanding, holding space for grief, and relationships. The findings indicate that siblings desire support from other siblings bereaved through suicide, as well as social support free from stigma that is willing to listen. The relationship between the suicided sibling and the living sibling had effects on the grief experience, as well as parentification, and effects from organisational interaction.

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

A Narrative Evaluation of a Grief Support Camp for Families Affected by a Parent's Suicide

Background: Children of parents who suffer mental ill-health and die by suicide are vulnerable to developing psychological and social problems themselves; they also have a severely elevated risk of dying at a young age - particularly through suicide. This highlights the need to design supportive measures that can counteract such negative developments after a parent's suicide. Aim: This narrative evaluation of a grief support camp for families affected by a parent's suicide arranged by the non-profit organization Children's Rights in Society in Sweden investigates whether children [N = 11] and parents [N = 11] perceived their participation as meaningful and, if so, in what way, and the changes to which the program was said to have contributed. Methods: Family members were invited to reflect on their experiences in narratively structured interviews that took place 18 months after participation. Their narrated experiences were analyzed to examine how the program was integrated into their biographies and with what significance. Narratives of change were identified in particular in order to grasp the self-perceived effects of participation. Results: Both children and parents attributed major significance to their encounters with other suicide bereaved. This led to support exchange and normalization, which countered a perceived "suicide stigma" in everyday life. Help to narratively construct destigmatizing understandings of suicide was also said to have relieved self-blame and shame. Overall, the participants described changes in the form of a better-informed position in grief, increased manageability and enhanced family communication. The parents also reported improved ability to support their children and a more hopeful view of life ahead. Conclusion: The evaluation showcases how this psychoeducational intervention, at a relatively low cost compared to traditional approaches, has great potential to lessen the negative effects of a suicide in the family by assisting families with psychological processing and de-stigmatization. Parental resources are also strengthened, which can serve as continuing support for the children.

Research-Based Theater and "Stigmatized Trauma": The Case of Suicide Bereavement

Background

Existing research shows that family members who suffer the loss of a loved one through suicide often experience self-blame and shame, and that this limits their grieving process. It can also lock them into stigmatized positions and the notion that either somebody or a dysfunctional family is to blame for the suicide.

Aim

This article investigates from a narrative perspective how a theater play might counteract the stigma that surrounds suicide bereavement by contributing destigmatizing understandings of suicide.

Methods

A theater play was performed in a churchyard theater in Stockholm, Sweden, in 2019. Audience members were asked to write down their free reflections on a form distributed at the theater. In particular, they were asked to assess whether they found the play related to their own lives and, if so, how; and to describe what they had learned. Their written reflections [N = 41] were analyzed from a narrative methodological perspective to investigate their responses to the play. Three categories of audience member were identified from their responses: people with their own suicide bereavement experiences; people with similar but different experiences of stigmatized trauma; and people who did not report any experiences of suicide or stigmatized trauma.

Results

The suicide-bereaved generally reported familiarity with the thematic performed, in particular the "why question," the blame and shame responses and the silenced family communication. Most of these aspects were also shared by those affected by other types of stigmatized trauma. Respondents from all categories emphasized how they had learned that suicide is a desperate rather than a deliberated act, caused by overwhelming emotional pain or depression. Ultimately, suicide was perceived as an involuntary death caused by complex interacting factors linked to both inner vulnerabilities and stressful life events, for which no one was to blame.

Conclusion

The results show that research-based theater isa time-limited and cost-effective method of introducing alternative meanings and identities to both individual mourners and the broader cultural context from which stigma originates, and how it can have destigmatizing effects on a stigmatized trauma such as suicide bereavement.

Survivors' perceptions of support following a parent's suicide

Children who experience a parent's suicide are vulnerable to an increased risk for mental health disorders and suicide attempts. In this study, 17 adults, each a child survivor of their parent's suicide, shared their perceptions of support following the suicide. Helpful experiences included opening communication about suicide and offering individualized support. Unhelpful experiences included judgment and blame, silence regarding suicide, and a heightened awareness of the surviving parent's challenges. Individuals most helpful in meeting the child's needs included those with preexisting relationships. In particular, our findings emphasize the critical need for honest, open, and age-appropriate communication about the parent's suicide.

Liberating burdensomeness of suicide survivorship loss: A Critical Interpretive Synthesis

AIMS AND OBJECTIVES

What is an interpreted and synthesised understanding of responses of survivors to a suicide death of a close person?

BACKGROUND

It is well known that survivors of suicide loss who are in a close relationship with the deceased are at high risk for suicidality and health conditions. Nurses in various settings need evidenced-informed approaches to encounter these vulnerable persons and support their healing journey from postvention to prevention.

DESIGN

The design is reflexive and iterative.

METHOD

A Critical Interpretive Synthesis comprised of six phases: formulating the review question; searching literature; sampling; determining quality; extracting data; interpretive synthesis. Qualitative content analysis was also.

RESULTS

Based on a sample of 15 published full-text qualitative and quantitative nursing research studies published between 1990 and 2016, an aggregated, interpreted and synthesised understanding of responses of survivors of suicide loss to the suicide death of a close person emerged. Four synthesised concepts were: dreading burden of suicide risk and stigma; facing burdensomeness in the aftermath of suicide death; enduring being burdened-unburdened, striving to invest in living; and liberating burdensomeness, journeying toward healing.

CONCLUSIONS

Contextually, geo-cultural gaps exist in published nursing studies. Most studies were from North American and a few from Asia. The reported suicide deaths occurred over a wide range of time. Conceptually, four synthesised concepts can be viewed as a process of moving from burdensomeness to liberating burdensomeness. Methodologically, a small body of knowledge that met quality appraisal was interpreted and synthesised into an understanding of an evidenced-informed approach to guide nurses' encounters with survivors of suicide loss.

RELEVANCE TO CLINICAL PRACTICE

The results contribute to an evidenced-informed approach for nurses in practice to support survivors of suicide loss journeying from burdensomeness to liberating burdensomeness. Results also serve as a foundation for further research.

The Stigma of Suicide Survivorship and Related Consequences-A Systematic Review

Background

considerable proportion of the population experiences major life disruptions after losing a loved one to suicide. Social stigma attached to suicide survivors adds to complications occurring in the course of suicide bereavement. Despite its known risks, stigma related to suicide survivors has been sparsely investigated.

Methods

We conducted a systematic literature search in PubMed, Web of Science, PsycInfo and PsyArticles, of studies indexed up through August 2015. Articles were eligible for inclusion if they addressed experiences of stigma in suicide survivors, compared them to other bereavement populations, or investigated stigmatizing attitudes within the public. The search was restricted to English-language studies.

Results

25 records matched inclusion criteria. Study designs were heterogeneous, making comparisons difficult. Results demonstrated that suicide survivors experience stigma in the form of shame, blame, and avoidance. Suicide survivors showed higher levels of stigma than natural death survivors. Stigma was linked to concealment of the death, social withdrawal, reduced psychological and somatic functioning, and grief difficulties. Only one study investigated stigmatizing attitudes towards suicide survivors among the general population.

Limitations

Internal and external validity of the studies was restricted by a lack of valid measures and selection bias.

Conclusions

More methodologically sound research is needed to understand the impact of stigma on suicide survivors’ grief trajectories and to separate it from other grief aspects. Clinicians and grief-counselors as well as the public should be educated about the persistent stigma experienced by suicide survivors.

The Healing Alliance: How Families Use Social Support after a Suicide

This article is based on a study that investigated family responses to suicide using a qualitative methodology. The intent of the study was to expand our understanding of family responses to suicide by asking the question, “What changes do families experience after a suicide?” One aspect of the data revealed how families use social support to integrate the death into its history. It was found that healing alliances created within and outside the family sustained its members as they engaged in the painful process of personal re-definition and family transformation.

Grieving, Mourning, and Healing Following Youth Suicide: A Focus on Health and Well Being in Families

Within the context of their grieving families, this grounded theory study explored survivors' experiences of healing following youth suicide. The major theme developed in this study, Journeying Toward Wholeness, is conceptualized as a process involving the inter-relationships among three sub-themes: Grieving in Response to Youth Suicide, Mourning in Response to Youth Suicide, and Healing in Response to Youth Suicide. Initially, grieving, mourning, and healing occur within individual and family realms. Theoretically congruent with systems theory, this mid-range grounded theory suggests that grieving, mourning, and healing are embedded within a broader social context. This theory purports that grieving, mourning, and healing are related, dynamic, and seamless processes influencing each person's journey toward wholeness following youth suicide. This theory supplements the basis of holistic practice, directs us to accept a broad range of survivors' expressions of movement towards wholeness and health, stresses the importance of working with survivors' stories, and encourages us in relational practice.

Survivors of Suicide: A Comprehensive Bibliography Update, 1986–1995

An update of a 1985–86 Omega bibliography of the literature on survivors of suicide is presented. Following brief introductory comments, including the identification of research and therapy needs and unresolved issues, the bibliography listings are organized by the following subtopics: general references on family members and friends as suicide survivors; children, adolescents, youth, and parents as survivors; school and educational settings; parental suicide; elderly suicide survivors; mental health professionals and clinicians in training as survivors; survivors of professionals' suicides; and research on attitudes toward survivors. Published works in professional journals, books, book chapters, and doctoral dissertations on the topic of survivor-victims are included.

The Aftermath of Suicide among African Americans

This article describes an exploratory qualitative study that examined the impact of suicide on a group of 19 African American families who lost a family member to suicide. The majority of suicide survivors were women who lost children to suicide. The participants were interviewed for an average of 2.5 hours using a semi-structured interview that was developed by the author. The majority of survivors felt that they had to go through the grieving process alone. Those survivors who did receive support most often received it from family members and friends. Most of the respondents felt that the support, if any, that was offered from the church was unhelpful. Negative attitudes about suicide from the broader community and from family members made it more difficult for these families to grieve.

Prominent Feelings and Self-Regard Among Survivors of Suicide

This cross-sectional study explores associations between elapsed time since the loss and outcomes of main feelings surrounding the loss and self-regard among 187 help-seeking survivors bereaved by suicide. Chi-square tests were conducted to examine the aforementioned relationships. In examining suicide survivors' main feelings over time, this study found mixed results in early bereavement. This study showed that at 25 to 59 months of elapsed time since the loss, both fear and happiness were significant for suicide survivors. No significance was found before 25 to 59 months, suggesting a change in suicide survivors' main emotions following 2 years of elapsed time since the loss. In later bereavement (i.e., 5 + years), suicide survivors' experiences of happiness was significant. The aforementioned results suggest that following 2 years of elapsed time since the loss, this sample of survivors bereaved by suicide experienced a change in their grief experience.

Bereavement after the suicide of a significant other

CONTEXT

It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors.

AIMS

The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors.

MATERIALS AND METHODS

Careful MedLine and PsycINFO searches for the period 1980-2013.

RESULTS

The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide.

CONCLUSION

Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors.

PRACTICE IMPLICATIONS

It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions.

Continuing bonds after suicide bereavement in childhood

It has been argued that the grieving process after suicide bereavement has unique properties (e.g.,J. R.Jordan, 2001). A qualitative study was conducted to explore one aspect of the grieving process--continuing bonds--after suicide bereavement in childhood. Data were collected through semi-structured interviews with 10 suicide-bereaved children and analyzed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). Three themes are discussed: thinking about the deceased, coping strategies, and ongoing connections to the deceased. The findings highlight potentially unique qualities of continuing bonds after childhood suicide bereavement and factors that might influence their adaptiveness. Theoretical and clinical implications are outlined.

How do the young suicide survivors wish to be met by psychologists? A user study

Little user-knowledge has been documented on the experiences of young suicide bereaved with psychosocial assistance and therapy. Thirty-two adolescents who had lost a close family member or friend by suicide participated in a research project by filling in questionnaires and participating in focus group interviews. The article explores the young people's experiences with and wishes for help from psychologists, and shows that the young bereaved do not receive the psychological assistance they wish for and need. The shortcomings are discussed in relation to the organization, form, and contents of the help. In order to reach youth with adequate assistance in an extreme life situation, it is worth listening to their opinions about how they want to be approached in the wake of a suicide.

Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions

The experience of bereavement by parental suicide is not well understood, as evidenced by the lack of empirically supported interventions for this underserved population. This article reviews quantitative and qualitative research on the psychopathological outcomes and thematic characteristics of childhood and adolescent suicide survivorship and moderating variables such as life stressors, stigma, the manner of communication about the suicide, and the surviving parent's functioning. The authors outline several approaches to intervention and address conceptual and methodological challenges within the field. With the ultimate goal of efficacious intervention, recommendations for future priorities and the use of unconventional research methods are offered.

Can suicide be ethical? A utilitarian perspective on the appropriateness of choosing to die

In his article in the current issue of Death Studies, "Can Suicide be a Good Death?" David Lester argues that each person should determine whether suicide is appropriate for him or her in relative isolation from the opinions of others. In the present article, I use a utilitarian ethical perspective to critique this assertion. According to utilitarianism, the "goodness" of an action is judged by its impact not only on the individual, but also upon others. As such, I review research demonstrating that suicide has harmful emotional, interpersonal, and economic effects upon individuals and society. Ultimately, the rightness or wrongness of choosing to commit suicide cannot be determined in isolation from the broader consequences of this choice.

Do suicide survivors suffer social stigma: a review of the literature

One of the delineating elements found in suicide bereavement versus normal bereavement is the stigma experienced by survivors. This review of the literature will provide insight into stigma as an underlying element in suicide bereavement and point to the role of health professionals in dealing with this complex issue. Historical review and empirical studies are analyzed to provide a framework for how suicide relates to natural bereavement. The conclusion is that suicide bereavement is different from natural loss. The challenge to health care providers is to sort through the complex issues surrounding the individual and their social network to find mechanisms that lead to resolution. Suicide has a profound effect on the family, friends, and associates of the victim that transcends the immediate loss. As those close to the victim suffer through bereavement, a variety of reactions and coping mechanisms are engaged as each individual sorts through individual reactions to the difficult loss. Bereavement refers to "all the physiological, psychological, behavioral, and social response patterns displayed by an individual following the loss (usually through death) of a significant person or thing" (Dunne, Dunne-Maxim & McIntosh, 1987). Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. It is further complicated by the societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors. This individual or societal stigma introduces a unique stress on the bereavement process that in some cases requires clinical intervention.

Grief as a transformative experience: weaving through different lifeworlds after a loved one has completed suicide

Using Heidegger's hermeneutic phenomenology informed by van Manen's and Benner's work, this research is an exploration and interpretation of the lived experiences of family members since they lost a close family member to suicidal death. Data from in-depth interviews with six participants, the researcher's journal entries and published literature were analysed. Findings gave rise to a grief model where suicide survivors moved through four modes of being-in-the-world characterized by 13 lifeworlds or themes. Surviving suicide was a transformative process that in time enabled survivors to discover new ways of understanding and relating to the world. The findings have implications for nurses and counsellors working in the area of suicide bereavement.

Children of suicide: the telling and the knowing

Amidst the still limited literature on survivors of suicide, and the particularly scanty literature on children of parental suicide, little focal attention has been given to the special issues surrounding surviving parents telling the children that their deceased parent's death was a suicide. Those few papers that deal with this topic have primarily emphasized the destructive consequences of not telling of the suicidal nature of the death, with imperatives to tell the children the whole truth and do so promptly post-death. Based primarily on clinical and preventive work with children of suicide, this absolutism and one-size-fits-all approach is questioned, the difference between being told and knowing accented and illustrated, and the nature and effects of surviving parent explanatory frameworks for the suicide--the 'why' of it--explored.

Survivors of Suicide: Emerging Counseling Strategies

1. Effective intervention with survivors of suicide requires knowledge of the diverse sequelae of response including blame, anger, guilt, shame, search for why, and feelings of stigmatization. 2. Fearing blame and stigmatization, survivors of suicide may be reluctant to contact helping professionals. 3. Duration and intensity of bereavement is mediated by the survivors' nature of the relationship with the deceased and their perception of the preventability of the death. 4. Group counseling is an effective intervention because it addresses the issue of disenfranchised grief.

Do they suffer more? Reflections on research comparing suicide survivors to other survivors

This article contrasts public perceptions of suicide survivors with conclusions based on comparative studies of suicide, fatal accident survivors, and other survivors. Although suicide is commonly thought to cause a particularly burden-some grief, quantitative studies have often failed to support this. We then offer some interpretations of these findings and suggest future pathways for research.

A theory of healing in the aftermath of youth suicide. Implications for holistic nursing practice

The purpose of this family-focused, grounded-theory study was to develop a substantive theory that explains how individual family members heal in the aftermath of youth suicide. Individual healing following youth suicide is conceptualized as a process of "journeying toward wholeness." In response to youth suicide, survivors characteristically tap into their innate strengths and coping capabilities. Eventually, most survivors move toward healing. Precipitated by youth suicide, individual healing was found to be a contextually mediated, ongoing, dynamic, and recursive process. Most often initiated by a family survivor who was emotionally and spiritually close to the youth prior to suicide, healing emanated from the survivor's consciousness as an act of volition. This study brings to light the idea that bereaved family survivors of youth suicide have the potential to heal in response to the decisions they make and the healthy bonds they create and maintain between themselves and the deceased youth.

Adults mourning suicide: self-reported concerns about bereavement, needs for assistance, and help-seeking behavior

This study empirically characterized the experiences of 227 adult next-of-kin as they mourned suicides that had occurred in New York City during 1997. Next-of-kin reported psychosocial problems including family difficulties, comorbid stressors, psychiatric symptomatology, and unresolved bereavement. Professional intervention was the most frequently reported need and the most frequently reported type of desired help. In terms of actual receipt of assistance, participants reported having received help from families, friends, and communities as well as from professionals. Although some next-of-kin had not sought help because they felt able to cope without assistance, others encounted barriers to receiving desired help. These findings warrant increased and sustained community outreach to this population. Recommendations include public education regarding de-stigmatization of suicide and the needs of the suicidally bereaved, enhancement of internal and external coping supports, facilitation of access to both professional and community help, and better coordinated and more culturally appropriate services.

Family Interactions of Suicide Survivors and Survivors of Non-Suicidal Death

We studied the effects of the death of a child by suicide ( N = 34) versus non-suicide ( N = 46) on family dynamics of forty-one parents and thirty-nine surviving siblings. Participants were solicited through bereavement groups, flyers, and newspaper advertisements. Participants completed a demographic questionnaire, the Bloom Family Interaction Scale, and a Closeness/Distance questionnaire about four years post death. Results included: 1) disengaged or conflicted families experienced greater distance while cohesive or expressive families reported more closeness; 2) sibling survivors felt closer to their fathers after the death than before and reported more family conflict than did parents; 3) there were no differences between suicide survivors and non-suicide survivors in perceived closeness between family pairs before or after the death.